Perimenopause

What is perimenopause?

Perimenopause refers to the transitional period of time before menstruation actually stops, which is marked by changes in the menstrual cycle, along with other physical and emotional symptoms. Perimenopause can last two to 10 years and during this time the following processes are occurring within a woman's body:

Ovaries release eggs less regularly

Ovaries gradually produce less estrogen and other hormones

Fertility decreases

Menstrual cycles shorten, there are fewer ovulations, and more cycle irregularity

Circulating levels of estrogens and progesterone are markedly reduced

Androgen (androstenedione) is reduced

Testosterone decreases

What causes perimenopause and perimenopausal symptoms?

Perimenopause is caused by the declining function of the ovaries. Ovulation may become erratic and then stop altogether. The menstrual cycle length and flow may become irregular before the final menses (last menstrual period).

Q: "I am 44 years old and starting to think I'm going crazy. I have three school-aged children and work full-time, so, granted, I am under a great deal of stress. The last six months I've had a few irregular menstrual cycles where I'm two weeks late for my period, and my PMS symptoms, which used to be quite mild, are worse than ever coupled by severe mood swings. Also, I feel my level of concentration diminishing and I'm forgetting things I should not be forgetting. I hear a lot about these things happening as a woman gets closer to menopause, but my mother says I'm a little young for this. What could be going on?"

A: Menopause actually occurs when a woman permanently stops having menstrual periods. The transitional period of time before menstruation completely stops is referred to as perimenopause. During this period of time there are great fluctuations in hormones, which can produce many of the same symptoms you are experiencing. Many women think they are too young to be going through perimenopause, but, while perimenopause generally starts between one and six years before menopause, it can actually start up to 10 years before menopause. And, with the average age of menopause being 51 years of age, that starting age for perimenopause could be as young as 41 years old.

It is important to describe all of your symptoms to your doctor. He or she may even have you chart a few cycles and keep track of your symptoms. Your doctor will also recommend ways to relieve your symptoms and help you through the transitional years of perimenopause with as little discomfort and disruption as possible.

The symptoms of perimenopause may resemble other medical conditions. Always consult your doctor for a diagnosis.

As fluctuations of hormones occur, symptoms result from the changing levels of estrogen and progesterone in the body. At times, estrogen levels may be higher, which may trigger symptoms similar to premenstrual syndrome (PMS). At other times, the estrogen levels may decrease, which may trigger hot flashes or night sweats. This fluctuation of estrogen levels may be interspersed with normal menstrual cycles during perimenopause. Research studies demonstrate that perimenopausal women show varying patterns of hormonal fluctuations. No two women will experience perimenopause in the same way.

What are the symptoms of perimenopause?

The following are the most common symptoms of perimenopause. However, each woman may experience symptoms differently. Symptoms may include:

Mood changes

Changes in sexual desire

Difficulty concentrating

Headaches

Night sweats

Hot flashes

Vaginal dryness

Sleep disturbances

Joint and muscle aches

Extreme sweating

Frequent urination

Similar symptoms as experienced with PMS

The symptoms of perimenopause may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

Treatment for perimenopause

Specific treatment for perimenopause will be determined by your health care provider based on:

Your age, overall health, and medical history

Current symptoms

Your tolerance for specific medications, procedures, or therapies

Your opinion or preference

More and more health care providers are treating perimenopausal symptoms. These treatments may include:

Other lifestyle changes your health care provider may recommend include the following:

Eat a healthy diet with fruits and vegetables and whole grains.

Get at least 1,000-1,200 mg of calcium each day through your diet or supplements.

Exercise regularly.

Identify what triggers hot flashes (for example, coffee or tea) by keeping a diary or record to help reduce their likelihood.

Discuss the use of other treatments in relieving menopausal symptoms with your health care provider.

Some of the same suggestions used for coping with hot flashes in menopausal women may also be helpful for perimenopausal women. It is important to remember that herbal supplements are not subject to regulation by the FDA, and, therefore, have not been tested in an FDA-approved clinical trial to prove their effectiveness in the treatment or management of medical conditions. Consult your health care provider about symptoms you are experiencing and discuss herbal supplements before beginning use.